Orthopaedics: Hand

 Evaluation of Hand Complaints

 

 History

·                 hand dominance, AM stiffness, location ofpain, swelling, mass, trauma, activity, neurological symptoms, history of arthritis

 

Physical Examination

·                 deformities

o       fracture: rotational or angular

o       rheumatoid arthritis: ulnar deviation, swan neck, boutonniere, mallet finger

·                 finger position

o       Dupuytren's contracture: flexion contracture of 4th/5th finger

·                 swelling/masses

o       Heberden's node: DIP swelling

o       Bouchard's node: PIP swelling

o       rheumatoid arthritis: MCP swelling

·                 skin changes

·                 nail changes: dubbing, koilonychia, leukonychia, Lindsay's nails, Terry's nails, onycholysis

·                 muscle wasting: thenar, hypothenar, intrinsics

·                 range of motions, crepitus, joint line tenderness, joint stability

·                 all bones, including carpal bones, can be palpated to identify maximum tenderness

·                 neurovascular examination

 

Special Tests of the Hand

·                 test of flexor digitorum profundus

o       flex DIP while holding MCP in extension

o       if unable to flex DIP, then suggestive of flexor digitorum profundus pathology

·                 test of flexor digitorum superficialis (sublimes)

o       flex PIP while holding MCP in extension

o       if unable to flex PIP only, then suggestive of flexor digitorum superficialis pathology

·                 test of thumb instability

o       apply a valgus stress to thumb while stabilizing metacarpal; keep MCP flexed slightly while testing

o       if there is laxity in thumb, then suggestive of ulnar collateral ligament rupture

·                 test of finger instability

o       apply varus and valgus stress to finger while stabilizing PIP

o       if there is laxity in PIP, then suggestive of collateral ligament damage

·                 Allen's test

o       occlude both ulnar and radial artery; release one at a time to determine patency of each artery

·                 Finklestein's test

o       place thumb in palm and cover with all fingers and move wrist into ulnar deviation

o       if pain is reproduced at radial styloid region, then suggestive of tenosynovitis of 1st compartment (EPB, APL tendons)

·                 test of carpal tunnel syndrome